HealthPro Solutions Creating Performance Intelligence.

In Kenya healthcare performance measurement, performance-based healthcare governance mechanisms and the utilization of healthcare performance intelligence by different end-users are key to today’s healthcare system challenges study from Kenya Demographic Health Survey (KDHS, 2019) and about 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget. In 1978 the declaration of (Alma-Ata) at the International Conference on Primary Health Care launched primary health care as a route to better health for all. The ambition was bold. The Declaration of (Alma-Ata) responded to a world characterized by vast and largely avoidable differences in the health status of populations, and mapped out a strategy for reducing these gaps through fundamental changes in the way health systems measuring their performance indicators and organized for care delivered. As the Declaration of (Alma-Ata) argued, enlightened policy that made fair access to health care an explicit objective could raise the level of health within populations, enabling people to lead socially and economically productive lives, and thus driving overall development.

Globally study from World Health Organisation Academy (WHO, 2018) healthcare systems are under strain because of ageing populations with demands based on multimorbidity, unmet needs of vulnerable populations, overuse and underuse of healthcare services and the advent of (disruptive) technologies and personalized diagnostics and treatments. Balancing between improving population health, delivering quality care for individuals, and containing costs is a timely social and economical challenge in Kenya. Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030. Healthcare systems need to achieve a balance between improving the health of populations, delivering quality care for individuals, and containing costs. This so-called Triple Aim is mirrored in policy discourse by terms like ‘high-value healthcare systems’, ‘resilient healthcare systems’, ‘responsive healthcare systems’ and ‘sustainable healthcare systems’ (Guttmatcher, 2020). Achieving the targets for primary health care PHC requires an additional investment of around US$ 200 to US$ 370 billion a year for a more comprehensive package of health services.

Health services research (BMC, 2019 ) report that primary health care and its strengthening through performance measurement is essential for sustainably working towards universal health coverage. Existing performance frameworks and indicators to measure primary health care capture system functions like governance, financing and resourcing but to a lesser extent the function of services delivery and its heterogeneous nature. Moreover, most frameworks have weak links with routine information systems and national health priorities, especially in the context of high-and middle-income countries. At the UN high level universal health care UHC meeting in 2019, countries committed to strengthening primary health care. WHO recommends that every country allocate or reallocate an additional 1% of GDP to PHC from government and external funding sources.

Ideal of the programming scaling-up innovation namely HealthPro solution is to integrate equitable tools and metrics, implementing methods to streamline healthcare performance measurement indicators, include governance and utilization that match the different health care systems in Kenya and in the near future mapping transferability to nearby countries Uganda, Tanzania and Malawi will probably asked for the support and network of the innovation HealthPro dissemination tools and strategy plan for transition to scale up to other Sub-Sahara countries in the next 3-5 years.

Singularly our programming is solely to scale-up HealthPro Solutions of an integration of five (5) proposed innovations for sustainably ecosystem tricks provide functioning of new ways for measuring primary health care performance, creating effective intelligence improving universal primary health care UPHC coverage in Kenya, furthering this project of HealthPro Solution have been implemented in UN High and Middled income countries e.g Canada, Eu. Netherlands implementing HealthPro and through joint callaboration with Youth Alliance for Change Kenya to  scaling-up to Africa by end of 2030.

• Deploy an Immersion Community-Based Approach to PhD training consisting of an innovative programme of collaborative, multi-disciplinary, and entrepreneurial training. This will secure interaction with key stakeholders, opinion shaper’s establishing a closeted link to the practice ensuring applicability of the results, and will expose fellows to a myriad of career opportunities which they can develop during their training for primary health care implementation measuring.

• Develop Healthcare Performance Intelligence Professionals with transferable skills relevant to the current research environment such as data handling and interaction with stakeholders enabling them to be effective agents of healthcare system and strengthening performance in Kenya.

• Develop new and evaluate existing tool and methods (such as performance frameworks, dashboards, logic models, advanced statistical methods and risk profiling) for measuring, interpreting and translating healthcare performance data into actionable healthcare performance knowledge and indicators and transferring them to healthcare governance mechanisms enabling performance-based healthcare supporting the achievement of the Triple Aim (Policy).

• Gain understanding of factors affecting utilisation of healthcare performance intelligence by end-users.

• Broaden transitions or scaling-up the adoption of Immersion Community Centred training of researchers and the utilisation of healthcare performance intelligence through transfer-based promotional efforts.

Our programming namely HealthPro Solutions is to serves and make great strides in the domain of measurement of Health Care Performance. Against the backdrop of an ageing population and advances in health technologies it is vital that health systems can make better use of data to measure performance, to develop analytics, make better use of prescribing data and use advanced analytics to quantify risk.

Broadly ideal based on scaling up HealthPro Solutions is up to-points focus to harness governance tool and policy commonly applied in the private sector and to test their suitability and applicability for the public health sector. This will benefit and achieved by advancing on methodological challenges in the context of real-world evidence and value-based care delivery, reflecting forthcoming paradigms for health system development e.g. Up-to-date established a baseline by preparing (systematic) reviews on the gathered research and published first articles and dissemination indicators toolkits, thus to advanced stage of manuscript preparation and learned indicators.

• How professionals behave when they have to deal with performance issues,

• Identifying models able to catch out how the healthcare services perform at the organizational and process level-especially when they are in charge of the whole patient clinical pathway units e.g. (diabetes care, cancer, malaria, HIV/AIDs, tuberculosis and COVID-19 care units etc.),

• Testing, in a specific sector (e.g. long-term care) whether the performance measures available in each sub country constituency can be comparatively used and which is the effect of data public disclosure on the performance. 

Our programming innovation of HealthPro solution impact is to challenge and transform data information serves into primary health care strategies and actionable plans. Hence, the work of ours to provide insight on which nudges can increase the effectiveness of healthcare professionals’ actionable and which tools can be used to positively influence the measurement performance of healthcare organizations and are a good advancement in terms of knowledge to shareable across information systems thus to administrators managers and streamlined for data collectors and extensively strengthening the community health and primary healthcare services delivery.

The majority of the project team lead in-house are PhD representatives from Public Consortium Healthcare Strategy Network; Council of National Healthcare Insurance Fund and Private and Public Healthcare Advocacy-Task-Force engaged in the project Board of Trustees, Management and HealthPro Training Activities popularly having track record over 8 years experience and validation with historical in PhD Healthcare Performance Management and Competency-Based-Skills to strengthen the movement and functioning for community healthcare and primary healthcare performance and social services delivery coverage by engaging key influencers, healthcare decision-makers, policymakers for project effectiveness and results-driven track performance leadership. Solely to the Team Lead has gained experience in promoting measurement performance creating functioning intelligence and professionalism through this so called HealthPro solution sustainably improving primary healthcare in Kenya.

The Project Team has singularly conducted similarly project with live experience in measuring primary healthcare data, designing and implementation, monitoring and evaluation and statistical analysis. The team has grounded and proven commitment to developing, implementing, and scaling-up HealthPro solution in the area of primary health care performance intelligence project within local regional County Government of Homa Bay in Kenya and anticipated that with MIT Solve/Bill and Melinda Gates Foundation Grant we will use the grant for transition solutions for HealthPro in Kenya mapping 5 sub-regional. This has created strong connection and lived experiences with Council of Healthcare (CH) administrators, policymakers and advocacy tasks-force in relation to challenges faced in the healthcare systems performance measurement, performance-based healthcare governance mechanisms and the utilization of healthcare performance intelligence by different end-users. The Project team capacities comprise of social entrepreneurs with strong connections for HealthPro Solutions and to measurement performance indicators and governance mechanism in the primary health care settings. Furthering to the realization of project team level of effort to deliver sustainable impact at scale. The Project team has got understanding of local infrastructure and governance context including relevant laws and social, political, and economic contexts affecting primary health care system performance. The team addresses a major societal and healthcare challenge – the sustainability of healthcare systems and developing new ways of measuring performance and assuring performance indicators are acted upon for vulnerable populations, multiple chronic diseases, diabetes and integrated care also delivering advancements in how stakeholders, i.e. patients, healthcare providers, managers, insurance agencies are engaged in healthcare performance measurement, governance and improvement. The availability of high-level skills and proper methodology to build analytic models is vital to spin continuous quality improvement loops through audit, benchmarking and international cooperation.

We are applying Grant from MIT Solve Education in conjunction with Bill and Melinda Gates Foundation to increase modern health systems needed standardized measures to compare practices and validate them under different conditions, so that they can be successfully transferred elsewhere globalization to allow defining a comprehensive tool that can tackle key health system performance problems in different ways, thus improving functioning performance intelligence for governing an integrated healthcare and social services delivery network.

We anticipated that we will also use the grant funding to maintains close ties to a wide range of organizations in data academia, industry, pharma, governance, and purchasing (social health insurance, regional government). Immersion Community Members interact with fellows to present their company profiles, discuss how they can complement and contribute to the company’s work, offer work visits, take part in job speed-dates and in facilitated ‘Health Business Games’ to train them in understanding the different perspectives, politics and change processes of different sectors and companies. Furthering, the projects will help filling the gap between different silos of information by bridging different levels of care under innovation umbrella of scaling up HealthPro solutions. For instance, one of the project’s goal is to build predictive models that can produce reliable risk estimates of performance-related outcomes, unifying the needs of personalized medicine with the complex interrelations between environmental conditions, organizational arrangements and longitudinal care processes.

Nearly all outputs produced by HealthPro solutions will be able to be immediately applied as a product or service for assessing healthcare performance. The challenge is the adoption and effective use of healthcare performance indicators into healthcare governance mechanisms. The solution of HealthPro is improving this by developing better-suited indicators as well as models and tools for engaging stakeholders across all sectors to work together in healthcare performance measurement and governance.

In a snapshot HealthPro solution is an innovative functioning for scaling-up and transformative response for measuring performance intelligence for governing an integrated primary health care and social services delivery network coverage. Anticipated to measure healthcare system performance solely based on five (5) main approach- Healthcare System strengthening performance areas in a reliable, valid, meaningful and actionable ways based on available healthcare data to support the achievement of the Triple Aim Healthcare Awareness.

The following projects innovation approach are performed in this Work Package (links to the short description of the projects sustainably scaling-up HealthPro Solution)

WP 1. Healthcare Performance Measurement.

For innovation HealthPro solutions is to create functioning Healthcare Performance Measurement up-to-date focus on five (5) main approach - Healthcare System strengthening performance areas are: 1. Implementation of person-centred integrated service delivery models; 2. Patient and family engagement in healthcare; 3. Addressing inequality in access to quality healthcare for vulnerable populations; 4. Better outcomes through continuous quality improvement; 5. Reduction of ineffective health spending and waste in healthcare. 

• HealthPro Solutions Approach 1: Composite measures for quality of health care for patients with chronic conditions: as we comparing apples and pears?
• HealthPro Solutions Approach 2: Optimising the use of routine health databases for personalised risk profiling of patients stimulating patient engagement.
• HealthPro Solutions Approach 3: Measuring and improving the performance of integrated healthcare systems.

WP 2. Performance-based Healthcare Governance Mechanisms.

To interpret and translate healthcare performance indicators into actionable health system and services performance information and knowledge, and to integrate this into meaningful healthcare governance mechanisms to support the achievement of the Triple Aim.

• HealthPro Solutions Approach 4: The role of managerial systems in promoting integrated care pathways.
• HealthPro Solutions Approach 5: Results-based (corporate) governance-tools for healthcare.
• HealthPro Solutions Approach 6: Consumer engagement in healthcare purchasing by insurers: Reducing waste, increasing value.

WP 3. Utilization of Healthcare Performance Intelligence by different end-users.

To impact the actual use of performance intelligence by the different end-users by providing performance evaluation systems and tools able to stimulate changes in organizational behaviour at regional and local level. This Work Package focuses on the utilization of healthcare performance data and their impact on the overall system organization and on the behaviour of the stakeholders (policymakers, health professionals, patients and users).

• HealthPro Solutions Approach 7: Improving the uptake of performance reports via nudges.
• HealthPro Solutions Approach 8: The impact of automated international comparisons using routine large scale databases to improve diabetes care and mental health illness.
• HealthPro Solutions Approach 9: Reputation counts: putting benchmarking at work
• HealthPro Solutions Approach 10: Effective use of performance reporting in long-term care.

Based on current approach and multiple experience as the (Overall Impact Goals) priorities in the next 1 Years presented and thus also will be up-to-point replicated to other nearby country/or globalization in the next 5 Years for HealthPro Solutions scaling up.

Overall Impact Goal:

• Train first generation of Healthcare Performance Intelligence Professionals that can make effective use of available healthcare performance data in Kenya to improve integrated service delivery, patient engagement, equality in access to healthcare, health outcomes, and reduce waste in healthcare.
• To increase new ways of healthcare performance measurement at least for 200 primary health care strengthening universal health care coverage in Kenya by the end of Dec 2023.
• To increase legitimate performance-based healthcare governance mechanisms for 200 primary health care an integrated and social services delivery network in Kenya by end of Dec 2023.
• To increase consistency utilization of healthcare performance intelligence by different end-users enhanced for 200 primary health care in Kenya by end of Dec 2023.
• To increase formulation of 5 advanced Immersion Community Centred PhD training in Kenya to achieve the Triple Aim related performance goals (achieving a balance between improving the health of populations, delivering quality care for individuals, and containing costs) by building capacity and skills of 50 Healthcare Performance Intelligence Professionals with PhD by end of Dec 2023.

For scaling-up HealthPro solution, this are the top (4 Objectives) approach alignment will be implemented to help as achieve overall Impact Goal referred to this delivering HealthPro Solution countrywide and a times transition to globalization in the next 1-5 Years.

To achieve this four (4) Objective which is to increase new ways of healthcare performance measurement; Performance Based Healthcare Governance Mechanisms; Utilization of healthcare performance intelligence by different end-users; Formulation of immersion Community Centred within 1-year time frame, and in the next 5 years, we will prioritize and conduct this several activities and deliver measurable change and demonstrate HealthPro Solutions achievements.

Main Activity 1. Conduct HealthPro Solution of National Training Network for Healthcare Performance intelligence Professionals.

HealthPro is a national training network programme aims to deploy an immersion community centered PhD training programme to deliver to the first 50 generation of Healthcare Performance Intelligence professionals in multidisciplinary, multi-sectoral innovative scientific, technical and transferable skills and competencies, who will inform and support the necessary changes in health systems in five (5) regional locations counties around Kenya, HealthPros fellows work on a cohesive set of individual research projects related to measurement, governance and utilisation aspects of working with performance intelligence. We strongly believe that a harmonised approach towards developing and using performance intelligence in Health care–and creating a professional workforce to spearhead this process –should be one of Kenyan healthcare action’s focus policy  areas in the current and upcoming years.

Main Activity 2. Creating Effective Performance-based Healthcare Governance Mechanisms.

To interpret and translate healthcare performance indicators into actionable health system and services performance information and knowledge, and to integrate this into meaningful healthcare governance mechanisms to support the achievement of the Triple Aim.

Main Activity 3. Utilization of Healthcare Performance Intelligence by different end-users.

To impact the actual use of performance intelligence by the different end-users by providing performance evaluation systems and tools able to stimulate changes in organizational behaviour at regional and local level. This Work Package focuses on the utilization of healthcare performance data and their impact on the overall system organization and on the behaviour of the stakeholders (opinion Shaper’s, policymakers, health professionals, patients and users).

Programming integrate the following four priority that will best align with the proposed innovation Creating Sustained Performance Intelligence Strengthening HealthCare projects targets.

1. Increase new ways of healthcare performance measurement.

2. Increase legitimate performance-based healthcare governance mechanisms.

3. Increase consistency utilization of healthcare performance intelligence by different end-users enhanced. 4. Increase formulation of advanced Immersion Community Centred PhD training in Kenya to achieve the Triple Aim related performance goals. 

To measure priority within the project time frame, we will adopt evaluation approach and tools will be used to measure the priority e.g. Theory of Change, logical framework and organizational monitoring and evaluation policy-to boost and verify the performance and also generate other specific forms and other data collection tools that will be used for data collection, summary and analysis. 

1.0 Qualitative milestones targeting ensure the following:  

(a). Hold monthly review and planning meetings. 

(b). Conduct periodic quarterly review meetings. 

(c). Carry out weekly support supervision in the field. Interrogate and verify submitted reports Case studies. 

(d). Setting performance targets and follow-up on the percentage achievement. The actual field visits conducted and the output of the visit. Reviewing the workplan against the report – achievement summary. 

(e). Interrogation of data generated and analysed before submission or reporting. 

(i). First 50 generation with PhD enhanced literacy skills interpreting data supporting meaningful use of healthcare data. 

(ii). 1500 toolkits manual published for reference to streamlined data for collectors. 200 PhD teams providing sharable information across healthcare systems. 

(iii). Increased level of satisfaction among 50 professional health care who access data information and services. 

2.0 Quantitative milestones target data collection from field to ensure report is of high quality and consistency. 

Expected several key indicators anticipated will be used to measure the health of this HealthPro innovation over the timeline 1 year:- 

(i). 50 PhD reached through outreach awareness and indirectly webinar activities. 

(ii). 150 Private health institution reached through outreach and awareness activities. 

(iii). 100 end-users with changes in knowledge or skills as a result of training on the innovation. 

(iv). 5 Immersion Community Centred PhD established for training in Kenya to achieve the Triple Aim related performance goals.

Overall oriented standard programming theory of change (ToC) components

Impact Goal:-

• Is to train at-least first generation of Healthcare Performance Intelligence Professionals that can make effective use of available healthcare performance data in Kenya to improve integrated service delivery, patient engagement, equality in access to healthcare, health outcomes, and reduce waste in healthcare.

Outcome.

• To increase new ways of healthcare performance measurement at least for 200 primary health care strengthening universal health care coverage in Kenya by the end of Dec 2023.
• To increase legitimate performance-based healthcare governance mechanisms for 200 primary health care an integrated and social services delivery network in Kenya by end of Dec 2023.
• To increase consistency utilization of healthcare performance intelligence by different end-users enhanced for 200 primary health care in Kenya by end of Dec 2023.
• To increase formulation of advanced Immersion Community Centred PhD training in Kenya to achieve the Triple Aim related performance goals (achieving a balance between improving the health of populations, delivering quality care for individuals, and containing costs) by building capacity and skills of 50 Healthcare Performance Intelligence Professionals by end of Dec 2023.

Outputs:

• Increased awareness on healthcare performance measurement strengthening universal primary health care coverage.
• Access results-based (corporate) governance-tools for healthcare.
• Transformation inquisition data manual to effective technology systems impact of automated international comparisons using routine large scale databases.
• Changes in, and implementation policy and laws putting benchmarking at work.

Inputs:

• Organisation capacity strengthening.
• Technical analysis and advice through consortium approach with end-users.
• Knowledge advocacy awareness better informed healthcare opinion Shaper’s and hold decision makers to account.
• Improved access to flexible, response and adaptive of healthcare performance measurement.
• Improved delivery of interventions as a result of shared evidence and learning with MIT Solve Grant and marketing.
• Shift in social attitudes and behaviours resulting in positive change into healthcare performance based measurement.
• Improved access, supply and quality of basic services for Healthcare performance measurement.

Activities.

• • HealthPro Solution Approach 1: Establish and equip 5 Immersion Community Centred for training first 50 generation of Healthcare Performance Intelligence Professionals.
  • HealthPro solution Approach 2: Composite measures for quality of health care for patients with chronic conditions: as we comparing apples and pears?
  • HealthPro Solution Approach 3: Optimising the use of routine health databases for personalised risk profiling of patients stimulating patient engagement.
  • HealthPro Solution Approach 4: Measuring and improving the performance of integrated healthcare systems.
  • HealthPro Solutions Approach 5: The role of managerial systems in promoting integrated care pathways.
  • HealthPro Solutions Approach 6: Results-based (corporate) governance-tools for healthcare.
  • HealthPro Solutions Approach 7: Consumer engagement in healthcare purchasing by insurers: Reducing waste, increasing value.
  • HealthPro Solutions Approach 8: Improving the uptake of performance reports via nudges.
  • HealthPro Solutions Approach 9: The impact of automated international comparisons using routine large scale databases to improve diabetes care and mental health illness.
  • HealthPro Solutions Approach 10: Reputation counts: putting benchmarking at work.
  • HealthPro Solutions Approach 11: Effective use of performance reporting in long-term care.

We will established HealthPro Solution online website and use other globalization awareness raising event characters, E-commerce and online health education advertisement, mapping public social media platforms, international network events and mass media e.g. TV programs advert, local FM Radio, manual toolkits with 5 interpretation languages for those who cannot access internet device and webinar training meetings forums through engagement of opinion Shaper’s and decision makers to raise awareness activities thus can course viral penetrations to support concerns of creating sustained performance intelligence strengthening healthcare measurement and governance mechanism furthering appropriate utilisation of Healthcare Performance Intelligence by different end-users.

We have active monitoring and evaluation manager who is responsible for the process, which will be conducted on monthly or quarterly basis to measure the challenges. 

Program innovation takes into account gender equality considerations. At board and management levels, women, girls and people with diverse sexual and genders are equally represented. This ensures diversity and equal participation. People of all genders are involved as decision-makers in projects design and implementation. When developing policies and designing projects. The organisation involves all genders to ensure their diverse needs and challenges are represented at policy levels and addressed through inclusive implementation. The aspirations of all genders are represented at all levels. The organisation policies are responsive to diversity and promote specific needs of gay, lesbian, men, women and transgender people LGBTI. Furthering program HealthPro solution adopts a human rights-based approach by integrating human rights principles into its design and implementation. Intel will address inequality and marginalization against girls’ rights as end-users by involving them in needs identification and prioritization of interventions and will ensure transparency, accountability, equal participation, inclusivity and equity among stakeholders and beneficiaries. Healthcare professionals, will be involved in measuring change and in on-going innovation refinement process through provision of timely feedback. The feedback will highlight areas to improve and this will ensure effective adoption, scale up and innovation integration into the public health sector.

Actually we are non-profit organisation (NGO) with mandate business model plan known as HealthPro Solution that prioritize to reach first generation with PhD alignment with healthcare management and train them on new and effective use of available healthcare performance data in Kenya to improve integrated service delivery, patient engagement, equality in access to healthcare, health outcomes, and reduce waste in healthcare furthering best practices for performance measurement, governance mechanism and utilisation healthcare performance intelligence end-users. We are focusing to engage of a consisting of an innovative programme of collaborative, multi-disciplinary, and entrepreneurial training. This will secure interaction with key stakeholders, opinion shaper’s, medical learning institutions, university for establishing a closeted link to the practice ensuring applicability of the results, and will expose fellows to a myriad of career opportunities which they can develop during their training for primary health care implementation measuring and bold decision to account. HealthPro solution will marketed it’s usual business model plan via a vast of channel e.g. E-commerce and online health education advertisement, international network of healthcare performance, Immersion Community Centred Media, Globalization awareness raising event, thus creating streams for HealthPro solution Revenues and Opportunities Grants internationally, nationally to gear the process and scale-up the HealthPro Solution in Kenya and nearby countries Uganda, Tanzania and Malawi.

Project HealthPro innovation will become sustainable as it will be integrated into national development plans to access funding from National Development Fund (NDF). Programming HealthPro innovation will engage Chiefs, Councillors and Legislators to allocate National Funds to sustain change and deploy an immersion community centered PhD training programme to deliver to the first 200 generation of Healthcare Performance Intelligence professionals in multidisciplinary, multi-sectoral innovative scientific, technical and transferable skills and competencies, who will inform and support the necessary changes in health systems in five (5) regional locations counties around Kenya, HealthPros fellows work on a cohesive set of individual research projects related to measurement, governance and utilisation aspects of working with performance intelligence. Most importantly, the professionals will have skills that will be put into practice in unforeseeable future and consequently be transferred to the next generation and we will generate required interest from development partners who will bring experience, expertise, linkages and funding for HealthPro innovation will sustain the change by creating referral linkages with permanent or national service providers.

As important of this HealthPro solutions impact strategy plan, value meaningful engagement of gender inclusivity factor and empowerment process rendering national training for PhD participatory to curb-barriers into users and engage End-Users Insight (EUI) and User-Based Design (UBD) to critically become champion and agent of change creating functioning of new ways of performance measurement strengthening healthcare as a model growth for transition to scale -up HealthPro solutions resulting into financial sustainability even after the end of funding with MIT Solve and Bill and Melinda Gates Foundation.

We also see into the feature to be financially sustainability furthering globalization donor approach requesting extra Grant Funding from National Development Funds (NDF), corporates foundation, multilateral and bilateral donors, especially from MIT Solve, Bill and Melinda Gates Foundation, Grand Challenge Canada for transition to scale-up project through proposal application and development.